Overdose : מינון יתר

4.9   Overdose

There have been reports of inadvertent overdosage with ‘Tiloptic’ resulting in systemic effects similar to those seen with systemic beta-adrenergic blocking agents 
such as dizziness, headache, shortness of breath, bradycardia, hypotension, bronchospasm, acute cardiac insufficiency and cardiac arrest (see section 4.8 ‘Side effects’).

If overdosage occurs, the following measures should be considered:

1.   Gastric lavage, if ingested. Studies have shown that timolol does not dialyse readily.

2.   Symptomatic bradycardia: atropine sulphate, 0.25 to 2 mg intravenously, should be used to induce vagal blockade. If bradycardia persists, intravenous isoprenaline hydrochloride should be administered cautiously. In refractory cases, the use of a cardiac pacemaker may be considered.

3.   Hypotension: a sympathomimetic pressor agent such as dopamine, dobutamine or noradrenaline should be used. In refractory cases, the use of glucagon has been reported to be useful.

4.   Bronchospasm: isoprenaline hydrochloride should be used. Additional therapy with aminophylline may be considered.

5.   Acute cardiac failure: conventional therapy with digitalis, diuretics, and oxygen should be instituted immediately. In refractory cases, the use of intravenous aminophylline is suggested. This may be followed, if necessary, by glucagon, which has been reported useful.

6.   Heart block (second- or third-degree): isoprenaline hydrochloride or a pacemaker should be used.